| Part A Hospital Services | C | F | G | N |
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| The Part A deductible is $1632 per benefit period A benefit period starts when you are admitted to a facility and ends 60 days after you last received inpatient care at any facilityPart A Deductible ($1632) |
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| Covers 365 Additional inpatient days after lifetime reserve has been used up365 days extra Hospital coverage | |
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| Skilled nursing facility coinsurance | |
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| 3 Pints of (unreplaced) blood | |
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| Part B Services | C | F | G | N |
| Part B Annual Deductible ($240) | |
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| Medicare covers 80% of Part B claims, you are responsible for 20%Part B Coinsurance | |
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You pay $20 for Dr. office visits You pay $50 for emergency room visits$20/$50 |
| Doctors who do not take Medicare Assignment can charge 15% above what medicare allows Some Medicare Supplement plans cover that extra 15%Part B Excess Charges |
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| Additional Features | C | F | G | N |
| Out of Pocket Limit | NA | NA | NA | NA |
| Hospice coverage | |
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| Foreign Travel Emergency | |
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| Monthly Rates & Brochures | C | F | G | N |
| Anthem | S: 687.41 I: Additional benefits included with Anthem Innovative plan rider
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493.44 | 530.92 | |
| Blue Shield eff 7/1/2024 | 675.00 | S: 539.00 Extra Rider
E: 572.00 |
490 | |
| Blue Shield to 6/30/2024 | 625.00 | S: 499.00 Extra Rider
E: 530.00 |
454 | |
| Health Net | S: 555.00 Additional benefits included with Health Net Innovative plan rider
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S: 454.00 Additional benefits included with Health Net Innovative plan rider
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428.00 | |
| UHC eff 6/1/2024 | 658.19 | 661.50 | 517.38 | 438.00 |
| Choosing a Medigap Policy | ||||
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Prepared for
Zip code: 92782 Age: 78 Spouse: 65 |
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UHC rates based on Part B effective 10 or more years UHC spousal rates based on Part B effective less than 10 years
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